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Delpazolid (LCB01-0371) Oxazolidinone antibiotic for MDR-TB 2018 - PowerPoint PPT Presentation

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Delpazolid (LCB01-0371) Oxazolidinone antibiotic for MDR-TB 2018 WGND Annual Meeting October 24, 2018 The Hague, The Netherlands Young Lag Cho LegoChem Biosciences, Inc., Daejeon, Korea Contents Overview of LegoChem Biosciences Key

  1. Delpazolid (LCB01-0371) Oxazolidinone antibiotic for MDR-TB 2018 WGND Annual Meeting October 24, 2018 The Hague, The Netherlands Young Lag Cho LegoChem Biosciences, Inc., Daejeon, Korea

  2. Contents • Overview of LegoChem Biosciences • Key Highlights of Delpazolid • Physicochemical properties • Mode of Action • Activity for MDR-TB • Phase I study summary • Ongoing Phase 2a EBA Study Overview • Conclusion and plan Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 2

  3. Company overview : LegoChem Biosciences, Inc. Leader in novel drug development with world-class researchers, technology, and global experiences What is Who we are? What we have? Core Competence? Company profile Core Technologies Development pipelines • Foundeda in May 2006 • LegoChemistry : Unique • Phase II : 1 (Delpazolid) scaffold based new • IPO in May 2013 • Phase I finished : 2 chemical drug discovery • 126 employees (66 in R&D) • IND stage : 3 • ConjuAll : Next-generation ADC Platform Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 3

  4. Delpazolid (LCB01-0371) : Key Highlights • Similar or better in vitro & in vivo activity compared to Linezolid against Efficacy most of G-positives and mycobacteria • No cross-resistance and Low resistant rate Excellent PK / PD profile (PAE in mouse: 11hr - 16hr) • • Reduced myelosuppression in animal and human study - No myelosuppression was seen in 21 days repeated phase 1 (MAD) study Safety up to 1200mg BID (2400mg / day) No CYP and QT prolongation issue • • Excellent human bioavailability (BA ~100%, PO / IV switchable) • No food effect PK • Low protein binding (37% in human) • Fast clearance with no accumulation • Orphan Drug Designation (ODD) FDA • Qualified Infectious Disease Product (QIDP) designation • Fast Track designation Designation Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 4

  5. Delpazolid: Physicochemical Properties Overview Delpazolid is Safe and Potent 2 nd Generation Oxazolidinone Antibiotics • Therapeutic Area : Infectious disease, Antibacterial • Target pathogen : Gram+ (MRSA, VRE, S. pneumoniae ), MDR-TB • Stage : Phase 2 (PO), Phase 1 (IV) Physicochemical properties Method LCB01-0371 MW MS 308.3 mp DSC 180~181°C pKa GLpKa 4.82 ± 0.005 logP GLpKa 0.19 ± 0.02 Permeability PAMPA -6.31 ± 0.06 (grade: medium) Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 5

  6. Delpazolid: Mode of Action Inhibition activity of protein synthesis in bacteria and mitochondria Animal Mitochondria Bacteria Human Mitochondria (reported)* Compound K562 cell (cancer AC16 cell (heart E.coli Rat, Rabbit (liver & heart) cell) cell) 4.8 uM 10.9 uM NA Delpazolid 2.6 uM 3.1 uM 10.0 uM 12.8 uM Linezolid 11.6 uM • E. coli : in vitro coupled transcription / translation assay • K562 cell: human chronic myelogenous leukemia cell line • AC16 cell: human cardiomyocyte cell-line * Ref : E. E. McKee, M. Ferguson, A. T. Bentley, T. A. Marks “Inhibition of Mammalian Mitochondrial Protein Synthesis by Oxazolidinones” Antimicrob Agents Chemother. 2006:50:2042–2049 Delpazolid showed superior activity compared to Linezolid in prokaryote but similar mitochondrial protein synthesis inhibition Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 6

  7. Activity for MDR-TB 1. MIC/MBC of MTB (H37Rv) 2. Intracellular Survival Assay MIC (ug/mL) MBC99 (ug/ml) 8 Delpazolid Linezolid Sutezolid 0.125 2 CFU (1 X 10 4 ) 6 Linezolid 0.5 >16 Delpazolid 0.5 4 4 2 0 ( μ g/mL) 3. Reported MIC of MDR-TB (n=120) and XDR-TB (n=120) isolates in China ref Linezolid Delpazolid MDR-TB MIC 90 1 ug/mL 0.5 ug/mL XDR-TB MIC 90 0.25 ug/mL 1 ug/mL ECOFFs (epidemiological cutoff values) 1.0 ug/mL 2.0 ug/mL Resistant rate of MDR-TB 6.67% 0.83% Resistant rate of XDR-TB 4.17% 4.2% *(Ref : Zhaojing Zong et al. “ Comparison of in vitro activity and MIC distributions between the novel oxazolidinone delpazolid and linezolid against multidrug- resistant and extensively drug-resistant Mycobacterium tuberculosis in China” AAC Accepted Manuscript Posted Online 29 May 2018, Antimicrob. Agents Chemother. doi:10.1128/AAC.00165-18) Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 7

  8. Phase 1 Study: Summary Study design : Double blind, randomized, placebo control, first-in-human design  N=64, 8 subject per group (6 active + 2 placebo) Phase 1a SAD  Doses: 50mg, 100mg, 200mg, 400mg, 800 mg, 1,600 mg, 2,400 mg, 3,200 mg MTD: 2,400mg (Up to 2,400mg, only mild adverse events were reported) Study design : Double blind, randomized, placebo control  N=32, 8 subject per group (6 active + 2 placebo) Phase 1b MAD-7days  Doses: 400 mg, 800 mg, 1,200 mg, 1,600 mg BID for 7 days MTD: 1,200mg BID (Up to 2,400mg/day, only mild adverse events were reported) Study design : Double blind, randomized, placebo control  N=36, 12 subject per group (10 active + 2 placebo) Phase 1b MAD-21days  Doses: 800 mg QD and BID, 1,200 mg BID for 21 days MTD: 1,200mg BID (Up to 2,400mg/day, No SAE reported) Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 8

  9. PK of LCB01-0371 in human_MAD 7day • PK parameter of LCB01-0371 at the Day1 in multiple-dose study PK parameter 400 mg 800 mg 1200 mg 5.62 (2.39) 11.15 (5.88) 13.83 (2.07) Cmax (ug/ml) Tmax (hr) 0.60 (0.14) 1.04 (0.75) 1.13 (0.63) 1.56 (0.07) 1.58 (0.17) 1.69 (0.17) T 1/2 (hr) AUC tau (ug*hr/ml) 7.79 (2.96) 19.46 (4.38) 38.15 (14.22) 7.83 (2.99) 19.56 (4.44) 38.56 (14.52) AUC 0-inf (ug*hr/ml) Accumulation ratio 1.13 (0.12) 1.47 (0.44) 1.11 (0.20) (D7AUC/D1AUC) Vz_F (l/kg) 2.02 (0.93) 1.49 (0.31) 1.28 (0.37) 0.91 (0.42) 0.66 (0.17) 0.54 (0.19) Cl_F (l/hr/kg) MRTlast (hr) 2.23 (0.20) 2.37 (0.29) 2.90 (0.43) 0.91 (0.39) 0.91 (0.48) 0.75 (0.11) Cmax_norm(kg/l) 1.27 (0.49) 1.59 (0.36) 2.09 (0.79) AUC 0-inf _norm(kg*hr/l)

  10. Why Delpazolid is safer than Linezolid? Plasma concentration of Delpazolid & Linezolid (Healthy human, phase 1 study) 16 LCB01-0371, 400 mg Plasma concentration (ug/mL) 14 LCB01-0371, 800 mg 12 LCB01-0371, 1200 mg Linezolid, 600 mg 10 8 6 Mitochondrial protein synthesis inhibition IC50 = 3.3 ug/mL 4 2 MIC = 0.5 ug/mL 0 0 2 4 6 8 10 12 Time(hr) Fast clearance rate of Delpazolid may relieve the mitochondrial toxicity

  11. Delpazolid: EBA Study Overview Outline of the ongoing Ph2a trial in Korea (Drug Susceptible Pulmonary Tuberculosis) Description Sites and Country 13 sites in Korea ≥ 80 Planed Treatment Period 2 weeks (14 days) EBA analysis by Korea Institute of Tuberculosis (KIT) Primary endpoint CFU count (solid culture) Safety parameters Laboratory, EKG, AEs, Vital sign Pharmacokinetics Pop PK Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 11

  12. Delpazolid: EBA Study Overview Title • – A Prospective, Randomized, Open, Active-controlled, Multi-center, Interventional, Exploratory, Phase Ⅱ Trial to Evaluate the Early Bactericidal Activities (EBA), Safety and Pharmacokinetics of Orally Administered LCB01-0371 in Adult Patients With Smear-Positive Pulmonary Tuberculosis • Primary Endpoint – EBA 0-14 • EBA(CFU) day 0-14=(log10CFU on day 14 - log10CFU on day 0)/(14-0) Delpazolid Delpazolid Delpazolid Delpazolid Total HREZ Linezolid (800mg/QD) (400mg/BID) (800mg/BID) (1200mg/QD) N 16 16 16 16 8 8 80 Strictly Confidential | June 2018 | LegoChem Biosciences, Inc | 12

  13. Patient disposition & Data analysis set: Interim analysis (N=48) Screened (N=57) * Interim analysis (N=48) Screening Cut-off date: results reported by Aug 16, 2018 failure (N=8) - Complete data (N=34) - Incomplete data (N=14) Enrolled (N=49) LZD 400mg BID 800mg BID HREZ 800mg QD (N=6) (N=6) (N=10) (N=15) (N=12) Interim analysis (N=6) Interim analysis (N=11) Interim analysis (N=10) Interim analysis (N=15) Interim analysis (N=6) Complete data (N=2) Complete data (N=3) Complete data (N=11) Complete data (N=7) Complete data (N=11) Incomplete data (N=4) Incomplete data (N=3) Incomplete data (N=3) Incomplete data (N=4)     contamination Contamination dropped out d/t dropped out d/t INH AE resistant   Contamination contamination  EBA 14 missing * Delpazolid 1200mg QD group was added recently and not enrolled yet

  14. Baseline characteristics (N=48) Variable Number Variable Number 51.6 S 48 ( ± 9.8%) INH-R Age (yr) mean (±sd) R 0 Male 40 Cavity (-) 12 Gender Cavity Female 8 Cavity (+) 36 ADM 32 ADM/OPD Unilateral 27 Bilateral lesions on CXR OPD 16 Bilateral 21 Yes 35 Medical 1+ 15 No 13 history 2+ 7 CDC smear score DM 15 3+ 9 HTN 7 4+ 17 Yes 41 First TB diagnosed HREZ 6 No 7 LZD 6 Complete 34 Completeness of data Randomized group 800 bid 15 Incomplete 14 400 bid 10 800 qd 11

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